Upper Arlington City School District
Forms
Table of Contents


5000 - STUDENTS
5111f2aResidency Affidavit
5111f2bAffidavit for Families Residing with Friends or Relatives
5111f4Superintendent's Agreement to Enroll a Nonresident Student
5111f7Power of Attorney: Sample
5111f8Caretaker Authorization Affidavit: Sample
5112f1Early Entrance Referral
5112f2Application for Waiver of Kindergarten Requirement
5112f3Referral Form for Possible Academic Acceleration
5113.01f1Intradistrict (Open) Enrollment Form
5130f2aStudent Withdrawal Form: Hastings Middle School
5130f2bStudent Withdrawal Form: Jones Middle School
5140f1Elementary School Lunch Period(s) Form
5140.02f1Middle School Lunch Period(s) Form
5140.02f1High School Lunch Period(s) Form
5200f1Planned Absence Excuse Form
5230f1Early Release Form
5320f2Immunization Exemption Form
5320f3Varicella Statement Form
5330f1Prescribed Medication Authorization
5330f1aAuthorization for Nonprescribed Medication or Treatment (Secondary School Version)
5330f1bAuthorization for Nonprescribed Medication or Treatment (Elementary School Version)
5330f1cRequest That Student Carry and Administer Own Medication
5330f1dRequest for Administration of Medication by Authorized Preschool Staff Member: Burbank Early Childhood School
5330f1eSpecialized Health Care or Emergency Care of a Student: Parent Authorization
5330f1fRequest for Specialized Health Care or Emergency Care of a Student: Physical Authorization
5330f2Medication Log
5330f3Prescribed Asthma Medication Authorization
5330f4Authorization for the Possession and Use of Epinephrine Autoinjector
5340f1Incident Report: Students, Employees, and Visitors
5341f1Emergency Medical Information/Authorization Form
5350f1Suicide Attempt Report Form: Sample
5350f2Assessment of Suicide Risk: Sample
5410f1Written Acceleration Plan Form
5410f2Referral Form for Possible Whole-Grade or Subject Acceleration
5464f1Request for Consideration for Early Graduation
5513f1Textbook Distribution and Collection Report
5513f2Breaking & Entering/Vandalism Report
5515f1Senior Parking Lot Regulations/Registration Forms
5517f1Report of Harassment - Student
5517.01f1Report of Bullying - Students
5605f1Log of Disciplinary Actions - Student with Disability
5610f2Notice of Intent to Suspend
5610f3aIn-School Suspension
5610f3bOut of School Suspension
5610f6Notice of Intention to Expel: Sample
5610f7Notice of Expulsion: Sample
5610f8Agreement to Hold Expulsion (Suspension) in Abeyance: Sample
5610.02f1Saturday Assignment: Hastings Middle School
5610.02f2A.M./P.M. School Detention Assignment: Hastings Middle School
5610.02f3School Detention Assignment: Jones Middle School
5610.02f4Saturday Assignment: Jones Middle School
5610.02f5After School Detention Assignment: Upper Arlington High School
5610.02f6Saturday School Assignment: Upper Arlington High School
5771f1Upper Arlington High School Locker Regulations
5830f1Fund-Raising Permission Form
5830f3Fund-Raising Final Report Form